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Electronic Health Records: Why We're Not Going to See Them by 2014

Back in 2004, President George W. Bush announced a grand plan that would guarantee all Americans an electronic health record by 2014. When Barack Obama was running for President, he reaffirmed that goal. But it's becoming clear that that was merely wishful thinking: As a new report reveals, under 10 percent of hospitals could qualify for government EHR incentives that become available Jan. 1, 2011.

The low percentage of hospitals that are ready to show "meaningful use" of EHRs signals that the $27 billion federal initiative to spread EHRs across the land may progress slower than expected. And, if that's the case, some health reform initiatives that depend on EHRs -- including medical homes and accountable care organizations -- may also develop more slowly than their supporters hope.

The hospital report from HIMSS Analytics, a research firm that tracks hospital IT, is based on a survey conducted last summer, before the Department of Health and Human Services released its final rule on EHR meaningful use. So the questionnaire asked about only 12 of the 14 "core" requirements and eight of the 10 "menu" criteria under the new rule. (Hospitals must meet all of the core and any five of the menu requirements.)

Little "meaningful use" of EHRs
The survey results showed that 9.61 percent of the participating hospitals could achieve the 12 core measures. Twenty-two percent could meet 10 or more of the core criteria, and 34 percent could attain between five and nine of those measures. About 40 percent of the respondents said they could meet five or more of the menu items for meaningful use.

On the positive side, most of the 687 hospitals that responded to the survey had some elements of an EHR. For example, around three-quarters of the hospitals had information systems that maintain medication and drug allergy lists and could do drug/drug and drug/allergy checks -- both core measures. On the menu, 73 percent of respondents could incorporate lab results as structured, searchable data; 65 percent could generate at least one report about patients with a specific condition; and 54 percent could report lab results to public health agencies.

But only 31 percent of the respondents said they could meet the core requirement for computerized physician order entry (CPOE), which is that more than 30 percent of patients with at least one medication have a drug ordered through CPOE. The percentage that can meet the requirement would have been much lower under the original criterion, which mandated CPOE use for 80 percent of orders. Also, John Hoyt, president of HIMSS Analytics, said at a press conference that the percentage would have been lower were it not that nurses and pharmacists, as well as physicians, can enter the orders under the final regulations.

Don't expect too much too quickly
Of hospitals that could not meet the top 5 core requirements, a majority said they planned to do so within a year. The same was roughly true for the top 5 menu criteria. That bodes well for hospital efforts to win some of the government incentive money. But as Hoyt admitted, hospitals don't always reach their goals.

The bottom line is that achieving meaningful use of EHRs in hospitals, even at the stage 1 level (stages 2 and 3 come in 2013-2015), will not be easy. CPOE alone is a massive undertaking that requires not only a large investment, but also the cooperation of physicians. So we shouldn't expect too much too quickly.

Money will get us only so far toward the goal of EHRs for everyone. The rest is up to the determination of providers and the willingness of payers to reward them for making the effort.

Image supplied courtesy of Flickr.